Dietitians inPrivate Practice

a guide for the consultant

consulting dietitians network—dc réseau dietetiste conseil

fourth edition

Dietitians inPrivate PracticeA GUIDE FOR THE CONSULTANT

FOURTH EDITION

ii dietitians in private practice contents

Synopsis .....................................................................................................vii

Acknowledgements ........................................................................viii

Purpose of the Manual ...................................................................x

Introduction ..............................................................................................xi

Section 1: The Concept ...............................................................................1

1.1 Entrepreneurial ................................................................................................................. 21.2 Why Choose Self-Employment? ..................................................................................... 6

The Plateaus and Pitfalls of Self-Employment ..................................................................... 7

Profile of a Registered Dietitian: Matthew Kadey, RD ....................................................... 7

1.3 Professional Opportunities .............................................................................................. 91.4 Considering the Costs .................................................................................................... 15 1.5 Starting Your Own Business .......................................................................................... 17

1.5.1 Critical First Step—Self-Evaluation .................................................................... 17

Top Tips for Aspiring Private Practice Registered Dietitians .......................................... 21

Dietitian Spotlight: Angel Luk, RD ..................................................................................... 24

Section 2: The Foundation ................................................................... 25

2.1 Should I Leave My Present Job? .................................................................................... 262.2 Business Plan Outline ..................................................................................................... 28

Niche Marketing: It’s not what you think! by Cyndi McLean ......................................... 30

Profile of a Registered Dietitian: Carol Donovan, RD ...................................................... 51

2.3 Financing ..........................................................................................................................53

cont

ents

1

2

iii dietitians in private practice contents

2.4 Financial Records ............................................................................................................ 552.5 Financial Policies and Practices .................................................................................... 55

2.5.1 Reimbursements and Receipts ............................................................................. 552.5.2 Determining Your Fee Schedule ......................................................................... 572.5.3 Billing Practices for Counselling ......................................................................... 582.5.4 Financial Aspects of Employment....................................................................... 592.5.5 Short- and Long-Term Goals .............................................................................. 592.5.6 Assessment Strategy .............................................................................................. 60

2.6 Negotiation Skills ............................................................................................................ 602.7 The Contract ....................................................................................................................612.8 Critical Appraisal ............................................................................................................ 622.9 Skills in Evidence-Based Practice ................................................................................. 63

2.9.1 Practice-Based Evidence in Nutrition® (PEN®) ................................................. 632.10 Best Practice and Continued Competency ................................................................ 652.11 Business Skills ................................................................................................................ 652.12 Entrepreneurship—What Does It Take? .................................................................... 66

Th e Power of Networking .................................................................................................... 68

2.13 Creativity Skills .............................................................................................................. 70

Dietitian Spotlight: Nancy Saunders, RD ........................................................................... 71

Section 3: Legal and Business Considerations.................72

3.1 Legal Counsel .................................................................................................................. 733.2 Your Business Registration ............................................................................................ 73

3.2.1 Sole Proprietorships ............................................................................................ 733.2.2 Partnership .............................................................................................................733.2.3 Incorporation ......................................................................................................... 733.2.4 Limited Liability Corporation ............................................................................. 76

3.3 Legal Aspects of Client Management ........................................................................... 773.3.1 Malpractice/Professional Liability Insurance .................................................... 773.3.2 Tenant Insurance ...................................................................................................773.3.3 Client Referrals ...................................................................................................... 773.3.4 Counselling Methods and Materials ................................................................... 77

3.4 Income Taxes ...................................................................................................................78

3

iv dietitians in private practice contents

3.5 Canada Pension Plan (CPP) and Employment Insurance (EI) ................................. 803.6 Employer Health Tax (EHT) ......................................................................................... 803.7 Workplace Safety and Insurance Board (WSIB) ......................................................... 803.8 Goods and Services Tax (GST), Harmonized Sales Tax (HST) ................................ 813.9 Subcontracting or Hiring Employees ........................................................................... 81

Hiring or Subcontracting Registered Dietitians in Private Practice ............................... 82

3.10 Credit Card Services ..................................................................................................... 863.11 Debit Card Services ...................................................................................................... 863.12 Online Transactions ..................................................................................................... 87

3.13 Third-Party Insurance ............................................................................................883.13.1 Companies that Cover Counselling Fees ......................................................... 88

Employee Health Insurance Infographic ........................................................................... 90

3.13.2 Employee Assistance Programs .............................................................................. 91

Third-Party Insurance ..........................................................................................................94

3.14 Dietitian Services as an Income Tax Deduction ....................................................... 963.15 Policies, Legislation, and Regulations ........................................................................ 963.16 Financial Planning ........................................................................................................ 97

Dietitian Spotlight: Andrea Falcone, RD ........................................................................... 98

Section 4: Building Your Business ............................................... 99

4.1 Positioning Yourself ......................................................................................................101

Profile of a Registered Dietitian: Loreen Wales, RD. ......................................................102

4.2 Business Cards ...............................................................................................................1034.3 Promotional Forms .......................................................................................................1044.4 Client Information Forms ............................................................................................1054.5 Waiver and Acknowledgement Forms .......................................................................106

4

v dietitians in private practice contents

4.5.1 The Personal Information Protection and .............................................................Electronic Documents Act (PIPEDA) .......................................................................... 106

4.6 Establishing Your Follow-Up Procedures ..................................................................1084.7 Identifying Your Referral Base ....................................................................................109

Finding New Opportunities ...............................................................................................1104.8 Establishing a Client Database ....................................................................................1124.9 Establishing Fixed Office Hours for Appointments .................................................1134.10 Establishing Session Guidelines ................................................................................1144.11 Establishing a Fee Structure, Appointment System, ....................................................

and Rules for Cancellations .......................................................................................1154.12 Establishing a Client Records System .......................................................................1164.13 Group Counselling .....................................................................................................1174.14 Evaluating Quality of Care .........................................................................................117

Dietitian Spotlight: Sarah Hamdan, RD ...........................................................................119

Section 5: Consulting Opportunities in Healthcare,

Business, and Industry ..............................................120

5.1 Opportunities in Healthcare ........................................................................................1215.1.1 Qualifications .......................................................................................................1225.1.2 Common Resources used in Healthcare ..........................................................123

5.2 Other Opportunities in the Health Field ...................................................................1315.3 Primary Healthcare Opportunities .............................................................................1325.4 Government Contracts .................................................................................................1335.5 Business & Industry ......................................................................................................1345.6 Pros and Cons ................................................................................................................1345.7 Independent Contractor Agencies ..............................................................................1375.8 Establishing a Contract ................................................................................................1375.9 Outsourcing ...................................................................................................................139

Negotiating Your Fees .........................................................................................................141

Dietitian Spotlight: Susan Watson, RD.............................................................................143

5

vi dietitians in private practice dietitians in private practice

Section 6: Ethical Considerations as a ........................................

Consulting Dietitian ......................................................145

6.1 Ethics, Standards, and Investigations .........................................................................1466.2 Codes of Ethics ..............................................................................................................1476.3 Common Professional Obligations that May Affect Business Choices ..................1476.4 Responsibilities to the Public.......................................................................................1506.5 Some Common Ethical Concerns ..............................................................................152

6.5.1 Referrals ................................................................................................................152 6.5.2 Diet Orders ...........................................................................................................1526.5.3 Selling Products ...................................................................................................1526.5.4 Kickbacks ..............................................................................................................1526.5.5 Conflict of Interest ..............................................................................................1536.5.6 Informed Consent ...............................................................................................1536.5.7 Misrepresenting of Ownership of Ideas ...........................................................1536.5.8 Research in Private Practice ...............................................................................1536.5.9 Inappropriate Behaviour from a Client ............................................................1546.5.10 Confidentiality of the Client ............................................................................1546.5.11 Educational Materials Versus Advice .............................................................1556.5.12 Evidence Versus Passion ...................................................................................156

6.6 Malpractice and Libel ..................................................................................................156

Dealing With Ethical Situations ........................................................................................158

Dietitian Spotlight: Helene Charlebois, RD .....................................................................160

Section 7: Technology Tools .............................................................. 161

7.1 Navigating the Online World ......................................................................................1627.1.1 Internet Jargon: Know Your Terms ...................................................................162 7.1.2 Internet Service Providers (ISPs) in Canada ...................................................1657.1.3 Recommended Software .....................................................................................1677.1.4 Data Security ........................................................................................................1687.1.5 Searching Tips and Tools....................................................................................169

7.2 Online Nutrition Resources .........................................................................................1727.3 Developing a Website ...................................................................................................172

6

7

vii dietitians in private practice dietitians in private practice

Profile of a Registered Dietitian: Cara Rosenbloom, RD ...............................................177

7.4 Other Opportunities for Technology .........................................................................179

Videoconference Counselling—Tips for Success By Wendy Busse ..............................181

7.5 Nutrient Analysis Software ..........................................................................................1897.6 Tablets and Smartphones .............................................................................................1917.7 File Sharing Tools .........................................................................................................193

Dietitian Spotlight: Jennifer Jones, RD .............................................................................194

Section 8: Online Marketing & Social Media ...................195

8.1 Professional Benefits of Being Online ........................................................................1968.1.1 Improved Networking ........................................................................................1968.1.2 Increased Access to Resources ...........................................................................196

8.2 Online Marketing by Kathy Colaiacovo .....................................................................1988.2.1 Website ..................................................................................................................1988.2.2 Blog........................................................................................................................1998.2.3 Email Marketing .................................................................................................2008.2.4 Lead Magnets .......................................................................................................2018.2.5 Social Media .........................................................................................................2028.2.6 Who are You online? ...........................................................................................2048.2.7 Social Media Content Success Formula: .........................................................2068.2.8 Final Tips to Achieve Online Marketing Success ............................................207

The Value of Social Media ..................................................................................................209

Dietitian Spotlight: Brooke Bulloch, RD ..........................................................................211

Section 9: Branching Out Your Business ..............................212

9.1 Staying in Business ........................................................................................................2139.2 Developing a Product-Based Business .......................................................................2149.3 Patents and Trademarks ...............................................................................................2179.4 How to Publish a Book on Nutrition ..........................................................................219

8

9

viii dietitians in private practice dietitians in private practice

9.5 Self-Publishing ..............................................................................................................2219.5.1 Preparing the Manuscript ..................................................................................2229.5.3 Getting an Estimate .............................................................................................2239.5.5 Preparing for a Print House ...............................................................................2259.5.6 Printing and Binding ..........................................................................................2269.5.7 Distribution ..........................................................................................................227

9.6 eBooks ............................................................................................................................228

Pillars & Pitfalls of Book Publishing .................................................................................230

9.7 Branching Out into Teaching ......................................................................................2349.8 Media Opportunities ....................................................................................................2359.9 Being a Media Spokesperson .......................................................................................2419.10 Advanced Education ...................................................................................................244

Profile of a Registered Dietitian: Leslie Beck, RD ...........................................................245

9.11 Selling Your Business ..................................................................................................247

Dietitian Spotlight: Casey Berglund, RD .........................................................................249

Dietitian Spotlight: Sandra Venneri, RD ..........................................................................250

Concluding Remarks .....................................................................251

Index ............................................................................................................ 253

© 2016 Dietitians of Canada, Consulting Dietitians Network.

All rights reserved. The Guide may not be reproduced

(print or electronic copying), stored in a retrieval system,

or transmitted in any form by any means.

ix dietitians in private practice synopsis

If you are a registered dietitian (RD) requiring a comprehensive manual to assist in the planning, implementing and sustaining of your own thriving dietetic-based business, look no further than Dietitians in Private Practice: A Guide for the Consultant, Fourth Edition. Published by Dietitians of Canada’s Consulting Dietitians Network (CDN), this step-by-step guide is ideal for RDs considering a private practice yet also invaluable for those with an established business looking to promote growth and cultivate new challenges. Covering the complete cycle of a business—from start-up to its full potential—this newly expanded edition is subdivided into 9 sections brimming with helpful topics, including professional opportunities; legal, business and financial considerations; establishing and solidifying your reputation; ethical practices and responsibilities; and essential technology, social media, and online marketing tools. Complete with a myriad of insightful resources and tips to enhance your business’s efficiency, such as a self-evaluation quiz to assess your entrepreneurial potential and suggested readings, this indispensable handbook also offers an in-depth Toolkit providing relevant samples of business forms; business plan proposals; media releases; and spreadsheets for tracking revenues and expenses.

What’s new? › Brand new layout and format!

› Profiles, hot topics, and testimonials of entrepreneurial dietitians from across Canada offering insights and personalized advice to help you succeed!

› Updated Legal & Accounting section › New sections on Niche Business, Social Media, and Online Marketing

› Updated and simplified templates to get your business up and running

› Index allowing for easy navigation of all your favourite topics!

Synopsis

Consider the fourth edition of Dietitians in Private Practice the only map you’ll need to help reach your destination—that of a successful dietetic-based entrepreneur.

x dietitians in private practice acknowledgements

This is the fourth edition of the Consulting Dietitians Network’s private practice manual titled Dietitians in Private Practice: A Guide for the Consultant. The previous edition was published in 2009.

The Dietitians of Canada, Consulting Dietitians Network would like to acknowledge contributors of previous editions (2009, 2003) from which this manual is largely based. Thank you to former contributors including:

Alexandra AncaBeth ArmourKim ArreyLeslie BeckPeter BrockHelene CharleboisPatricia ChueyLynda CorbyKaren DavisonLinda Dietrich

Sandra EdwardsKrista FraserIlana Goodman Beth GouldNancy GuppyHolly HeartzSteve KinsleyJean LaMantiaBarb LedermannJanice Macdonald

Jennifer MarettVesanto MelinaAnet Mor Iyabo Musa Joy NorgaardNaomi OrzechBarbara ParisottoKristen Imfeld QuinnCathy RichardsPhyllis Reid-Jarvis

Cara RosenbloomFrancis ScovilHoward SeligLorraine Stanford Lizanne SteunenbergMary Sue WaismanJanine Woodrow

Managing Editor: Jodi Robinson (Co-chair 2010-2015) Administrative Editor: Amanda HamelAssistant Editors: Susan Watson and Andrea Falcone (Acting Co-chairs).

The Editors would like to thank the following section reviewers and contributors:

Leslie Beck blueCaribou Chartered Accountants Wendy BusseKathy Colaiacovo Kate Comeau

Karen Davison Carol Donovan Ross Dyck Corinne Eisenbraun Roberta Irvine Matthew Kadey

Abby Langer Karine Levy Cyndi McLean Andrea Miller Cristel Moubarak Mateen Pourgol

Phyllis Reid-JarvisCara Rosenbloom April Saunders Loreen Wales Susan Watson

Thank you to our Provincial Representatives for your contributions:

Brooke Bulloch Lisa CianfriniSamara Felesky-Hunt

Roxanne Laughlin Andrea Miller Beverley Noseworthy

Amanda O’Brien Huguette Samson-Bouchard Annie Tsang

Susan Watson

Special thank you to those who submitted template forms, recommended resources, pictures, and feature quotes throughout the manual:

Michelle ArcherCasey Berglund Jennifer Bewza Brooke Bulloch Helene Charlebois Patricia Chuey Andrea D’Ambrosio

Carol Donovan Andrea Falcone Sarah Hamdan Andrea Hardy Andrea HolwegnerJennifer Jones Charlene Kennedy

Shauna LindzonAngel Luk Cindy MacNeil Andrea Miller Cristel Moubarak Jodi Robinson Nancy Saunders

Joyce Schnetzler Jennifer Sygo Kim Wagner-Jones Susan Watson Sandra VenneriShaistha Zaheeruddin

Thank you to the following individuals:

Ken Dyment Copy Editing/Design

Jennifer D. Foster Consulting Writer/Editor

Cara RosenbloomContent Editor

Acknowledgements

xi dietitians in private practice acknowledgements

When referencing this manual, please use the following citation:Dietitians in Private Practice: A Guide for the Consultant, Fourth Edition. Dietitians of Canada, Consulting Dietitians Network, 2016.

Notations and DisclaimersThroughout this manual, the terms private practice, consultant, self-employed, and business are used interchangeably to reflect various aspects of entrepreneurial dietetics. During the preparation of this manual, every attempt was made to take into consideration all possible aspects of starting a private practice. It was difficult to take into account all of the possible differences in provincial regulations. When starting a business, it is imperative to conform to the regulations of the province in which you practice.

Private Practice Networking SocialsThe Consulting Dietitians Network can assist you in developing asuccessful business. In addition to this manual, the Consulting DietitiansNetwork supports networking among members. We encourage you to connect with your colleagues and spark new ways to strengthen your business. If you would like to host a networking social in your area, contact the Consulting Dietitians Network by email to learn how to attend or host a social: consulting@dietitians-network.ca

It’s all about

networking!

Toronto, Ontario Network Social, 2014

xii dietitians in private practice purpose of the manual

The purpose of this manual is to assist the registered dietitian in planning, developing, implementing, and sustaining his or her business.

To be a successful entrepreneur, you must:

› Be confident in your skills as a nutrition professional › Possess business savvy › Have the determination to work the hours required to make your venture a profitable one

Starting a private practice will change your professional and personal life. Each day offers a new challenge. As an independent practitioner, you are the decision maker. As a successful business person, you must contend with responsibilities such as:

› Paying expenses › Satisfying clients and creditors › Conforming to a variety of controls and regulations established by various levels of government

Knowledge of marketing, accounting, education, counselling, management, culinary practices, research, and law are some examples of other fields that can contribute to the successful operation of a dietetic-based business. Many private practitioners agree that the positive aspects of being an entrepreneur far outweigh the negative ones. The negative aspects of starting your own business are real, but not insurmountable. These shortcomings include:

› No regular paycheque › No fringe benefits such as allowances for sick days, health and life insurance, parental leave, vacation pay, and employer-provided retirement plans

However, with careful research and the development of a plan that defines business goals and objectives, the end result can be determined and projected.

Building your own business provides many benefits, such as career independence, freedom, and flexibility in applying professional goals, values, and methods. It gives you an opportunity for advancement that will challenge and excite you. These rewards are directly related to the effort exerted. With good business management skills, your private practice can be:

› Financially rewarding › Professionally satisfying › Personally gratifying

Purpose of the Manual

xiii dietitians in private practice introduction

We bring you this fourth edition with the intent to help guide you through developing, implementing, and sustaining a successful business. It will also help the dietitian with an established business to foster new challenges and promote growth. The services of a registered dietitian are an invaluable and needed resource for all facets of the healthcare and food-service industry.

In this time of healthcare reform, attention is directed on preventative medicine as a means to help control healthcare costs. In this current context, the entrepreneurial dietitian has many opportunities for consulting work, whether it is doing individual counselling, consulting for healthcare, business or industry, or leading preventive programs targeted at a healthy lifestyle.

Consulting dietitians offer a variety of unique skills. The dietetics professional:

› Abides by evidence-based practice and client-centred care

› Assesses clinical, biochemical, and anthropometric measurements

› Addresses dietary concerns

› Evaluates feeding skills (i.e. as they relate to mealtime and dysphagia management)

› Assesses a client’s readiness to change and applies appropriate behaviour modification strategies

› Understands the determinants of health affecting his or her clients

› Applies his or her unique body of knowledge and expertise to support people in understanding and applying the principles of healthy eating throughout the entire life cycle

Introduction

xiv dietitians in private practice introduction

These professionals are educated in the science and management of nutrition and dietetics, and exemplify evidence-based decision-making to their practice. They also adhere to nationally established standards of practice that are monitored by provincial regulatory bodies. Over the years, the functions of entrepreneurial dietitians have evolved. Today, they engage in a wide range of activities that may include, but are not limited to:

› Adult education› Community needs assessments and development› Cookbook development, cooking classes, and food demonstrations› Corporate health and wellness programs› Distance/web-based education› Food-service systems design› Grant, proposal, and/or medical writing and/or authoring books› Advocacy or issue management› Mentoring or coaching› Resource development for consumers and/or professionals› Spokespersons for media, business, and/or industry › Management activities› Consultation to the health and business industry› Training of peer support workers and caregivers› Development of web-based programs (for example: apps)› Private counselling› Long-term care › Marketing› Media/public relations/communications› Program planning› Invention of products › Healthcare team participation › Supermarket or nutrition tours› Teaching in a variety of settings› Practice-based research and program evaluation

Dietitians are choosing self-employment for a variety of reasons. These can include the potential to increase their income, have more flexible hours, try new ideas, and work with motivated clients. According to an Academy of Nutrition and Dietetics membership survey (2016), successful self-employment has the potential to generate as much income as top jobs in education and food-service management. Your financial independence will be directly related to your business savvy and hard work.

xv dietitians in private practice introduction

This manual has evolved from the first edition to meet the changing needs of a consulting dietitian. This manual considers the full cycle of any business— from start-up to its full potential—and this edition is subdivided into 9 sections.

The Toolkit has been provided in addition to these sections and include various tools and resources that can be adapted to individual needs. These include samples of general forms for business and forms for the business focused on individual or group counselling, as well as forms for the business that targets healthcare, business, or industry sectors. Tools and resources include a sample proposal, business plan, media releases, and spread sheets for tracking revenue and expenses.

For your convenience, we have also created an Index, available at the end of the Manual, in hopes to encourage efficient retrieval of topics.

We wish you success in your business and hope this guide is helpful to you!

The Consulting Dietitians Network Executive, 2016

1 | The Concept

This section outlines the current entrepreneurial climate in Canada and the advantages and disadvantages to operating a business, as well as the professional opportunities that are available.

2 | The Foundation

Details of this section include how to start up your business, assess your entrepreneurial potential, and promote your business. It also highlights factors to consider for financing and record keeping.

3 | Legal and Business Considerations

This section of the manual highlights important matters such as business regulations, income taxes, HST/GST, third-party insurance, and relevant legislation and regulations.

4 | Building Your Business

Now that you have mastered the maze of starting up a business, you will need to use a variety of strategies to build your reputation and credibility. This section outlines these strategies.

xvi dietitians in private practice introduction

To be successful, live the dream and practice what you preach. You are your most-valued asset.

5 | Consulting Opportunities in Healthcare, Business, and Industry This section will explore a few areas in healthcare, business and industry in which dietitians can create working relationships, contracts and partnerships.

6 | Ethical Considerations as a Consulting DietitianBackground on ethical practice, issues of ethics, considerations in business behaviour, and ethical dilemmas the dietitian in private practice may encounter are discussed in this section.

7 | Technology Tools

Technology evolves rapidly, and we must adapt quickly. Learn which tools you can use to help enhance your practice.

8 | Online Marketing & Social Media

More and more dietitians are looking toward online marketing and social media as ways to promote and leverage their businesses. Learn how to stay abreast of trends in these areas, so that you can be better equipped to help your clients navigate the ever-changing nutrition information emerging in our world today.

9 | Branching Out Your Business

This section highlights a variety of areas to redirect or expand a nutrition-based business. For example, the potential to expand your business online and into global markets provides a whole new arena of possibilities for the ambitious nutrition entrepreneur.